Chemotherapy-Naïve Jejunal Lymphoma Fistulising With the Urinary Bladder

An elderly male was diagnosed with Crohn's disease empirically elsewhere and put on mesalamine tablets. A few months later, he developed acute dysuria and bile-stained urine. Computerized tomography revealed a contained jejunal perforation with a phlegmonous collection eroding into the dome of the urinary bladder with multiple intact tablets within it. At laparotomy, the affected segment of the jejunum and dome of the bladder were resected en bloc and intact mesalamine tablets were retrieved. Appropriate reconstruction was done. Histopathology examination confirmed it to be diffuse large B-cell lymphoma. Primary jejunal lymphoma is a rare occurrence with non-specific clinical presentation, posing diagnostic challenges. Perforation of chemotherapy-naïve lymphoma is uncommon and fistulizing into the bladder is even rarer.